Basic Information
| Provider Information | |||||||||
| NPI: | 1528133329 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUBAUGH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OWENS | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1005 MAR WALT DRIVE | ||||||||
| Address2: | FAMILY MEDICINE DEPARTMENT | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508636600 | ||||||||
| FaxNumber: | 8508620977 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 MAR WALT DRIVE | ||||||||
| Address2: | FAMILY MEDICINE DEPARTMENT | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508636600 | ||||||||
| FaxNumber: | 8508620977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9106007 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA04047 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | A10617 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.